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Basal cell carcinoma

Basal cell carcinoma is also known as BCC or rodent ulcer. Basal cell carcinoma is the most common type of cancer in humans and is particularly prevalent in the Australia and New Zealand. Luckily, it is very rarely a threat to life.

Who is prone to basal cell carcinoma?

BCC typically affects adults of fair complexion who have had a lot of sun exposure, or repeated episodes of sunburn. Although more common in the elderly, sun-loving New Zealanders frequently develop them in their early 40s and sometimes younger.

The tendency to develop BCC may be inherited, and is a particular problem for families with basal cell naevus syndrome (Gorlin syndrome) or Bazex syndrome.

Types of basal cell carcinoma

BCCs arise in otherwise normal appearing skin, unlike squamous cell carcinomas (SCCs), which often arise within pre-existing solar keratoses. BCCs can vary in size from a few millimetres to several centimetres in diameter. They usually grow slowly over months or years.

• Nodular BCC is often found on the face. It presents as a small translucent growth, often with rolled edges. If the contents are soft and can be expressed, it is known as cystic BCC. Nodular BCC may be pigmented (brown) and there are often small blood vessels on the surface. It may become an open sore (rodent ulcer), or bleed spontaneously then seem to heal over. Sometimes BCCs are difficult to distinguish from melanoma.
• Superficial BCCs are often multiple, most often on the upper trunk or shoulders. The patches are slowly growing, shiny pink or red and slightly scaly. They bleed easily.
• Morphoeic BCC, also known as sclerosing BCC, is the most difficult to diagnose, and is prone to recur after apparently adequate surgery. They look like a skin-coloured, rather waxy, thickened scar.

Nodular BCC	Superficial BCC	Ulcerated BCC
Pigmented BCC	Multiple superficial BCCs	Morphoeic BCC

More images of basal cell carcinoma ...

• BCC on the face
• BCC on the nose
• BCC on the eyelid
• BCC on the ear
• BCC on the limbs
• BCC on the trunk

Treatment

The treatment for a BCC depends on its type, size and location, the number to be treated, and the preference or expertise of the doctor. Possibilities include:

• Shave, curettage, & cautery (and other types of minor surgery). Many small, well defined nodular or superficial BCCs can be successfully removed by removing just the top layers of the skin. The wound usually heals within a few weeks without needing stitches.
• Excision. The lesion is cut out and the skin stitched up. This is the most appropriate treatment for nodular, infiltrative and morphoeic BCCs. Very large lesions may require a flap or graft to repair the defect after excision.
• Mohs micrographically controlled excision. In high risk areas of the face, ill-defined, morphoeic and recurrent BCCs are best removed by a dermatologic surgeon by the Mohs technique. This involves examining the carefully marked excised tissue under the microscope while the patient is still in the operating suite, layer by layer. It may take several ‘slices’ until the tumour has been completely removed. The defect is often much bigger than the BCC appeared to be before surgery because of hidden extensions of tumour cells under the skin.
• Photodynamic therapy. The tumour is treated with a photosensitising chemical in a cream (e.g. Metvix) or lotion, and exposed to light several hours later. Up to 85% superficial BCCs are cured, with excellent cosmetic results.
• Imiquimod cream. This is applied to superficial BCCs three to five times each week (Monday to Friday) for six to sixteen weeks. The imiquimod results in an inflammatory reaction, maximal at three weeks. Up to 85% of suitable BCCs disappear, with minimal scarring.
• Cryotherapy (freezing). Dermatologists sometimes use liquid nitrogen with a special ‘double freeze-thaw’ technique for small superficial BCCs. A blister forms, crusts over and heals within several weeks. A permanent white mark usually results from this treatment.
• Radiotherapy (X-ray treatment). This is less commonly used to treat BCCs than in the past. It may be a suitable way to eradicate skin cancer on the face in the elderly. The best cosmetic results are achieved by multiple ‘fractions’, e.g. weekly treatments for several weeks.

Whatever the chosen treatment, BCC can nearly always be cured. BCCs occasionally come back at the same site (recur), but they can be treated again by the same or a different method.

Those who have had one BCC are at increased risk of developing others within the next year or so. They are also at increased risk of other skin cancers, including melanoma. Early detection means easier treatment, and less scarring.

Protect your skin from the sun. Wear covering clothing and apply broad spectrum sunscreens to exposed skin daily during the summer months.

Arrange a complete skin examination from time to time. Ask your dermatologist or GP to check any persisting or growing lumps or sores or otherwise odd-looking skin lesions.